Cottage hospitals have a future after policy U-turn

Cottage hospitals are to be reprieved and the "biggest is best" philosophy that has held sway in the NHS for more than a decade is over, ministers said yesterday.

The Government has yielded to pressure to keep local hospitals open by declaring that the concentration of medical care in ever larger "palaces of disease" runs the risk of making services increasingly remote from local communities.

The pressure was exemplified at the last election by the success of Richard Taylor, an independent MP aged 66, a hospital consultant who stood on the issue of saving Kidderminster Hospital from closure and overturned a Labour majority of 7,000.

But the U-turn by the Government flies in the face of warnings from medical colleges that small hospitals cannot sustain the range of services necessary to deliver safe, effective care.

In June last year, a joint report from the Royal College of Physicians and the Royal College of Surgeons said that 59 hospitals in England and Wales were too small to maintain the range of services provided and were putting patients at risk.

However, ministers insist that with new resources and new models of care "small can work". Guidance issued to the NHS yesterday says advances in day surgery, using video links to allow remote diagnosis and more flexible use of staff can open up new possibilities for smaller hospitals.

Alan Milburn, the Health Secretary, said: "Patients want more, not fewer local services ... For too long the presumption has been that biggest is always best when it comes to hospital services. The starting point should be to examine how to keep as many services as local as possible."

Peter Morris, president of the Royal College of Surgeons, said the reduction in junior doctors' hours required under the European working time directive would put extra pressure on hospitals with smaller numbers of staff trying to maintain a 24-hour service. "There is no question that changes must occur," Sir Peter said.